Prise de poids et contraceptifs à progestatifs seuls: plus d'inquiétude que de preuves scientifiques. [Weight gain and progestin-only contraceptives: more concern than evidence].

Weight gain is a side effect often associated with progestin-only contraceptives. A recently published Cochrane review focuses on this issue that has been addressed in only few studies of good quality. Here we discuss the results of this review in the context of three clinical cases. With progestin-only contraceptives the weight gain is less than often thought, especially after six or twelve months of treatment. Some results are rather reassuring, especially those in obese women and during the post-partum period. This should help improve the compliance of women who fear gaining weight with this type of hormonal contraception.

Consolidation with Radioimmunotherapy May Prolong Survival in First Remission of Mantle Cell Lymphoma Patients Uneligible for Stem Cell Transplantation, An Analysis of the International RIT-Network

Background: Mantle cell lymphoma (MCL) is a rare subtype (3-9%) of Non Hodgkin Lymphoma (NHL) with a relatively poor prognosis (5-year survival < 40%). Although consolidation of first remission with autologous stem cell transplantation (ASCT) is regarded as "golden standard", less than half of the patients may be subjected to this intensive treatment due to advanced age and co-morbidities. Standard-dose non-myeloablative radioimmunotherapy (RIT) seems to be a very efficient approach for treatment of certain NHL. However, there are almost no data available on the efficacy and safety of RIT in MCL. Methods and Patients: In the RIT-Network, a web-based international registry collecting real observational data from RIT-treated patients, 115 MCL patients treated with ibritumomab tiuxetan were recorded. Most of the patients were elderly males with advanced stage of the disease: median age - 63 (range 31-78); males - 70.4%, stage III/IV - 92%. RIT (i.e. application of ibritumomab tiuxetan) was a part of the first line therapy in 48 pts. (43%). Further 38 pts. (33%) received ibritumomab tiuxetan after two previous chemotherapy regimens, and 33 pts. (24%) after completing 3-8 lines. In 75 cases RIT was applied as a consolidation of chemotherapy induced response; the rest of the patients received ibritumomab tiuxetan because of relapse/refractory disease. At the moment follow up data are available for 74 MCL patients. Results: After RIT the patients achieved high response rate: CR 60.8%, PR 25.7%, and SD 2.7%. Only 10.8% of the patients progressed. For survival analysis many data had to be censored since the documentation had not been completed yet. The projected 3-year overall survival (OAS, fig.1 - image 001.gif) after radioimmunotherapy was 72% for pts. subjected to RIT consolidation versus 29% for those treated in relapse/refractory disease (p=0.03). RIT was feasible for almost all patients; only 3 procedure-related deaths were reported in the whole group. The main adverse event was hematological toxicity (grade III/IV cytopenias) showing a median time of recovery of Hb, WBC and Plt of 45, 40 and 38 days respectively. Conclusion: Standard-dose non-myeloablative RIT is a feasible and safe treatment modality, even for elderly MCL pts. Consolidation radioimmunotherapy with ibritumomab tiuxetan may prolong survival of patients who achieved clinical response after chemotherapy. Therefore, this consolidation approach should be considered as a treatment strategy for those, who are not eligible for ASCT. RIT also has a potential role as a palliation therapy in relapsing/resistant cases.

Governance of Universities and Scientific Innovation

In this chapter the tension between the tendency of scientific disciplines to "diversify" and the capacities of universities to give new scientific fields an institutional "home" is tackled. The assumption is that new scientific fields must find support among scientists and cognitive units of universities in order to be included. As science is a strongly competitive social field, inclusion often meets resistance. It is argued in this chapter that opportunities for new scientific fields to be included depend on the kind of governance regimes ruling universities. A comparison of the former bureaucratic-oligarchic governance model in most European universities with the existing new public management governance model demonstrates that the propensity of universities to include new scientific fields has increased though there might be a price to pay in terms of which fields stand a chance of being integrated and in terms of institutional possibilities for the invention of new ideas.

Social inequalities of functioning and perceived health in Switzerland: a representative cross-sectional analysis.

Many people worldwide live with a disability, i.e. limitations in functioning. The prevalence is expected to increase due to demographic change and the growing importance of non-communicable disease and injury. To date, many epidemiological studies have used simple dichotomous measures of disability, even though the WHO's International Classification of Functioning, Disability, and Health (ICF) provides a multi-dimensional framework of functioning. We aimed to examine associations of socio-economic status (SES) and social integration in 3 core domains of functioning (impairment, pain, limitations in activity and participation) and perceived health. We conducted a secondary analysis of representative cross-sectional data of the Swiss Health Survey 2007 including 10,336 female and 8,424 male Swiss residents aged 15 or more. Guided by a theoretical ICF-based model, 4 mixed effects Poisson regressions were fitted in order to explain functioning and perceived health by indicators of SES and social integration. Analyses were stratified by age groups (15-30, 31-54, ≥55 years). In all age groups, SES and social integration were significantly associated with functional and perceived health. Among the functional domains, impairment and pain were closely related, and both were associated with limitations in activity and participation. SES, social integration and functioning were related to perceived health. We found pronounced social inequalities in functioning and perceived health, supporting our theoretical model. Social factors play a significant role in the experience of health, even in a wealthy country such as Switzerland. These findings await confirmation in other, particularly lower resourced settings.

Parenté flexible. Ajustements familiaux et accumulation de capitaux dans la diaspora chinoise en Polynésie française

Cet article interroge les pratiques familiales transnationales dans la diaspora chinoise à partir d'une étude plurigénérationnelle de la communauté chinoise en Polynésie française. Il conceptualise la notion de « parenté flexible » afin d'examiner comment la famille est mise au service de stratégies d'accumulation de divers capitaux culturels, symboliques, économiques mais aussi juridiques. La parenté flexible recouvre l'ensemble des pratiques consistant à jouer sur l'agencement et la composition de la famille en vue de s'ajuster aux, et de bénéficier des différentiels entre régimes et conjonctures en situation transnationale.Flexible Kinship. Family Adjustments and Capital Accumulation within the Chinese Diaspora in French PolynesiaDrawing from a multigenerational study of the Chinese community in French Polynesia, this article deals with transnational family practices in the Chinese diaspora. It conceptualizes the notion of "flexible kinship" to examine how family is used to develop strategies to accumulate various types of capital (cultural, symbolic, economic, as well as legal). Flexible kinship covers a range of practices that consist in playing on the arrangement and composition of the family group with the aim of adjusting to and profiting from differentials in regimes and conjunctures in a transnational situation.

Beyond EA Frameworks: Towards an Understanding of the Adoption of Enterprise Architecture Management

Enterprise architectures (EA) are considered promising approaches to reduce the complexities of growing information technology (IT) environments while keeping pace with an ever-changing business environment. However, the implementation of enterprise architecture management (EAM) has proven difficult in practice. Many EAM initiatives face severe challenges, as demonstrated by the low usage level of enterprise architecture documentation and enterprise architects' lack of authority regarding enforcing EAM standards and principles. These challenges motivate our research. Based on three field studies, we first analyze EAM implementation issues that arise when EAM is started as a dedicated and isolated initiative. Following a design-oriented paradigm, we then suggest a design theory for architecture-driven IT management (ADRIMA) that may guide organizations to successfully implement EAM. This theory summarizes prescriptive knowledge related to embedding EAM practices, artefacts and roles in the existing IT management processes and organization.

Occupational UV exposure in French outdoor workers.

OBJECTIVES: Occupational ultraviolet (UV) exposure was evaluated in a population-based sample in France. METHODS: A random survey was conducted in 2012 in individuals aged 25 to 69 years. The median daily standard erythemal UV dose (SED) was estimated from exposure time and place and matched to satellite UV records. RESULTS: A total of 889 individuals were exposed to solar UV with highest doses observed among gardeners (1.19 SED), construction workers (1.13 SED), agricultural workers (0.95 SED), and culture/art/social science workers (0.92 SED). Information and communication technology, industry, and transport workers were highly exposed (>0.70 SED). Significant factors associated with high occupational UV exposure were sex (P < 0.0001), phototype (P = 0.0003), and taking lunch outdoors (P < 0.0001). CONCLUSIONS: This study identified not only expected occupations with high UV exposure but also unexpected occupations with high exposures. This could serve as a basis for future prevention.